Chapter Three
Respondent
Someone smiling at us produces a pleasant feeling.
Pictures of good food may literally cause our mouths to water. In one type of
fetishism a man is sexually aroused by the sight of a woman’s shoe. A woman with
an automobile phobia may become anxious when she sees a car. Why should these
stimuli (smiles, pictures of food, women’s shoes, automobiles) elicit these
particular responses (a pleased feeling, salivation, sexual arousal, anxiety)?
It is not instinctual that these stimuli elicit these responses; hence it
probably is learned.
Perhaps one reason
a smile now elicits a pleased feeling is that in a person’s learning history
the stimulus of a smile was associated with other stimuli, such as affection,
which produced a pleased feeling. The stimulus of the image of the food was
associated with the stimulus of the taste of the food, with the taste eliciting
salivation. Eventually the image of the food came to elicit salivation. Similarly,
the sight of a woman’s shoe may have been paired with sexually arousing stimuli
such as from masturbation. The image of an automobile may have been paired
with an anxiety-producing stimulus such as seeing a close relative die in
an automobile accident. The learned associations may have been gradually built
up over time, as in the case of the smile and affection, or may have followed
a single dramatic learning experience, as in the case of the automobile accident.
This type of learning is called respondent conditioning,
the learning model in which one stimulus, as the result of being paired
with a second stimulus, comes to elicit a response it did not elicit just
previously. Usually this new response is similar to the response previously elicited only by the second stimulus. In this model the first
stimulus is called the conditioned stimulus (CS) and the response it
comes to elicit is called the conditioned response (CR), while the second stimulus is called the unconditioned stimulus (UCS) and
the response it already elicited is called the unconditioned response (UCR).
Figure 1 illustrates this for the case of the child who is gradually
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It is important to
realize how prevalent respondent conditioning is in human behavior, particularly
as it relates to emotional affect. Consider all the things that please or
displease you and all the situations that elicit emotions such as affection,
sexual arousal, anger, anxiety, or frustration. Consider how you differ in
these areas from other people you know or people from different times or different
cultures. Although some of these responses may be largely innate, such as
some reactions to physical pain, most of these reactions are learned, primarily
by respondent conditioning. Respondent conditioning in humans often is mediated
by language. If a friend tells you that George is a “racist,” then perhaps
some of your emotional affect to the word “racist” will become associated
to your image or memory category of George. Respondent conditioning is often
complex, involving more than associations between one particular CS and one
particular UCS. Thus a person may have negative feelings around older, male
authority figures based on experiences with his father, two elementary school
teachers, and a local policeman. Or a person may have bad associations to
bars in one part of town based on one personal experience, stories from friends,
and newspaper accounts. A person’s present reactions to certain situations
may be based on such a complex set of experiences that the person cannot readily
remember them, and they may be extremely difficult to trace back historically.
Fortunately, since behavior modification is ahistorical, this is not necessary.
Rather, we would determine the person’s current reactions to specific situations
and use our knowledge of respondent conditioning to change undesired reactions.
Let us consider a
few more examples. In a classic study Watson and Rayner (1920) made a loud
noise behind 11-month-old Albert whenever he reached for a white rat. This
noise (UCS) was frightening (UCR) to Albert and resulted in a fear (CR) of
rats (CS), as well as of other furry objects. A woman had two painful childbirths,
so that she became anxious when she learned she was pregnant again. Some teenagers
take up smoking tobacco even though the initial reaction to smoking may be
aversive. Here the associations to smoking, through sources such as peers
and advertisements, make smoking desirable. Chapter 7 deals with the effects
of rewards (reinforcement) and punishments on behavior. In human behavior most of the things that are rewarding (e.g., attention, approval,
money, good grades) or punishing (e.g., Ostracism, criticism) acquired their
affect through respondent conditioning and are called conditioned reinforcement and conditioned punishment (see
Mikulas, 1974b, p. 1 03).
Three important variables
affecting respondent conditioning are (1) temporal order of the stimuli, (2)
interstimulus interval, and (3) response dominance. Temporal order refers
to the fact that you generally get the best Conditioning if the CS precedes
the UCS (forward conditioning); while you generally get little or no
conditioning if the UCS precedes the CS (backward Conditioning). Early
attempts at treating alcoholism involved making the Person sick and then having
him drink an alcoholic drink. This is backward Conditioning, which probably
decreased the effectiveness of the program.
Backward conditioning,
however, does work in some situations, such as those discussed below under
response dominance; but the best approach is to establish forward conditioning.
Also in some situations, the CS and UCS occur together, not one before the
other. This may be inevitable, as when you cannot separate a person from one
of his characteristics, and may readily produce respondent conditioning.
Assuming forward
conditioning, the interstimulus interval, refers to the amount of time
from the onset of the CS to the onset of UCS. Generally, with many exceptions,
you usually get the best respondent conditioning with an interstimulus interval
of about one-half second. Although conditioning may occur with much longer
intervals (e.g., nausea from food poisoning may condition to the taste of
the food that occurred many hours earlier), in most behavior modification
programs, one-half second seems optimal.
Before conditioning,
both the CS and the UCS elicit responses. How ever, people seldom list the initial response to the CS, for it is usually relatively
minor in importance to the UCR and the later CR. Response dominance refers
to the relative strengths of the responses eIicited by the CS and UCS before
they are paired, the relative strengths of R1 and UCR in Figure 2. Now what
happens when we pair the CS and the UCS? If R1 and UCR are
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Other variables of
respondent conditioning include that the more times the CS and UCS are associated
(CS predicts UCS) the more the learning; within limits you often get better
learning with a strong UCS than a weak UCS; and you get poorer learning if
you have the learning trials (CS-UCS pairing is a trial) too close together.
APPLIED
RESPONDENT CONDITIONING
Establishing a new
response by respondent conditioning is often part of a behavior modification
program. Consider a person who is not sexually aroused by what he considers
desired heterosexual cues, but is only aroused by cues he considers
undesirable, such as an unusual sexual fantasy or homosexual stimuli. If such a
person is not offended by masturbation, we may gradually pair the desired
heterosexual cues (e.g., imagined scenes, photos) with the sexual arousal
associated with masturbation (e.g., Marquis, 1970). We would probably begin
with the stimuli that already elicit sexual arousal and gradually change from
these to the new desired stimuli. Then as the person later engages in sexual
behavior in the presence of the desired stimuli, the natural forms of
respondent association will take over. The respondent conditioning here is used
to overcome an initial obstacle, get things started, and turn the process over
to the regular course of events.
Enuresis (bedwetting)
is a problem affecting many children at all ages, including about 10 percent
of six-year-old children. In addition to being a problem by itself, it also
leads to other problems such as anxiety and guilt. A possible component of
some enuresis is that the child has a small bladder capacity and poor development
of related muscles so that the child urinates more both during the day and
at night (Yates, 1975, chap. 3). Treatment then often involves teaching the
child to have a larger bladder capacity by rewarding him during the day for
going for longer and longer times without urinating. In a few cases the enuresis
is because of excessive anxiety in the child and reducing the anxiety eliminates
the enuresis.
But the most common
approach for dealing with enuresis is the bell and pad or urine-alarm
procedure (Mowrer & Mowrer, 1938). The logic is that internal cues
of the bladder and related muscles are too weak to awaken the child at night
so that he may go to the bathroom before wetting the bed. Treatment uses a
specially constructed bed pad that when moistened by urine sounds a bell or
buzzer and wakes the child up. (Such devices are sold by Wards and Sears.)
The child now also begins inhibiting more urination as the bell rings. Since
increased muscle tension (CS) precedes urination and bell (UCS), which wakes
up the child and inhibits more urination (UCR), then by respondent conditioning
eventually the muscle tension alone will wake the child and inhibit bedwetting.
Thus the child is taught to respond to the internal cues that most people
use to control urination. This is a fast and relatively effective procedure
by itself and couples well with training in increasing bladder capacity. It
has also been successfully used with enuretic adults (Turner & Taylor,
1 974). There are other explanations for how the bell and pad procedure works
(see Doleys, 1 977; Lovibond, 1 964), such as the Child learning to wake up
to avoid the bell or buzzer.
Azrin, Sneed, and
Foxx (1 974) improved on this urine-alarm method by adding training in inhibitory
control, rewards for correct urination, training in rapid awakening, increased
fluid intake to increase the response rate, self-correction of accidents,
and practice in toileting. They reported significantly reducing bedwetting
after one night of such intensive training.
A spectacular example
of respondent conditioning is Efron’s (1957) report of treating an epileptic.
Most epileptics can detect the onset of a seizure by a subjective aura that
precedes the seizure. Efron found that one of his female clients could inhibit
her seizures by inhaling the odor of jasmine during the early stages of the
aura. Efron then respondently conditioned the smell to the sight of a bracelet.
Then she could inhibit the seizure by staring at the bracelet. Eventually,
just thinking about the bracelet could inhibit seizures. Interestingly, looking
at or thinking about the bracelet also elicited a subjective sense of smelling
jasmine. In terms of latency of effectiveness, the direct odor was faster
than seeing the bracelet, which was faster than thinking about the bracelet.
Eventually, the client would just have spontaneous experiences of the odor
of jasmine; but by then she was no longer having any seizures. This suggests
the whole process moved further back so that pre-seizure cues triggered off
the sense of jasmine and inhibited seizures. (This is a common sequence in
many self-control programs in which initially conscious components eventually
slide out of consciousness.) Finally, the occasional smell of jasmine disappeared
and there were still no more seizures. The generality of this case study to
other epileptics needs considerable more research.
Although there are
situations, such as those above, in which a new response needs to be established
by respondent conditioning, more often in behavior modification it is a matter
of changing or eliminating an undesired behavior. In respondent conditioning
there are two ways of dealing with undesired behaviors: extinction and counterconditioning.
Respondent
conditioning is accomplished by establishing a contingency (relationship)
between the CS and the UCS: the CS predicts to a certain degree the onset of
the UCS. If we terminate this contingency so that the CS is not associated with
the UCS, eventually the CS will no longer elicit the CR. This process is called
extinction. If a small child is scratched (UCS) by a cat (CS) and hurt
(UCR), then the child may develop a fear (CR) of cats. If the child now
encounters cats without anything bad happening, the fear may extinguish.
Sometimes following extinction, the CR may gain in strength over time. This is spontaneous
recovery. However, in practical situations, this is usually minimal; and
with further extinction the CR will no longer reappear.
There are basically
two ways of carrying out extinction: gradual and not gradual. The gradual
approach consists of moving through a sequence of steps, called a hierarchy,
toward the object or situation that elicits the strongest CR. The alternative
is to bypass most of these intermediate steps and confront the final situation
right away. (Actually these are not two different approaches, but two points
on a continuum of how many steps there are until approaching the final situation.)
For example, if a child had a fear of the water at the beach, a gradual approach
would involve slowly approaching the water, perhaps first playing on the beach
20 feet away from the water, then playing 1 0 feet away, then at the edge
of the water, then putting feet in the water, and so forth. The non-gradual
alternative may be to put or carry the child into the water until the fear
extinguishes.
Although extinction
is applicable to any respondently conditioned response, it is most used with
anxieties and fears. People are continually confronted with situations that
elicit some anxiety, such as standing up to the boss, making a presentation
before a class, or talking about something personal. If the person can approach
and be in the anxiety situation without anything unpleasant happening, then
some of the anxiety should extinguish. The following are some general guidelines
for using a gradual approach to the extinction of anxiety and fears: First,
it is necessary to establish a hierarchy of steps toward the feared object
or situation. It is generally better to have too many steps than too few.
Second, it is desirable to encourage, motivate, or reward the person for going
through the hierarchy. However, the person should move through the hierarchy
at a comfortable pace, extinguishing most of the anxiety at each step before
moving on. Finally, it is often useful to provide the person with a way to
reduce the anxiety while all this is taking place—perhaps by teaching the
person how to relax, having the person imagine pleasant scenes, or having
the person pretend to be someone who would not be anxious in this situation.
These aids, plus any rewards the person receives, help to reduce anxiety,
provide motivation, and produce some counterconditioning, as discussed later.
A good variation of the above is to first have the person gradually go through
the hierarchy of steps in his imagination and then in real life, the latter
called in vivo.
The non-gradual approach
to extinguishing fears involves immediately confronting the feared situation.
If a child learning to ride a bicycle falls off and hurts himself, his parent
may have him get right back up and try again. If a person feels anxious about
dancing in front of others in a nightclub, he may force himself to get up
and do it. This approach often works, but sometimes the resulting anxiety
is too great and the person ends up more anxious rather than less anxious.
Therefore, my bias is to generally favor the gradual approach, which although
slower is also safer. A variation of the non-gradual approach involves bombarding
the person with the anxiety-producing stimuli and/or keeping the person in the anxiety situation without escape. This
approach is called flooding and will be discussed in Chapter 4.
As will be seen throughout
this text, most behavior modification procedures can, to some degree, be carried
out in the imagination (see Chapter 9). Extinction carried out in this way
is called covert extinction (Cautela, 1971). There is currently little
research in this area, but the following is an example: Götestam and Melin
(1974) used covert extinction with four female amphetamine addicts (who were
mainlining 100—200 mg., 3—5 times per day). They had the clients imagine situations
in which they would inject themselves and had them imagine they felt no effect
from the drug. Following one week of this treatment, about 100 trials, there
was a decrease in the effect of the drug, even to the extent of the clients
getting no effect when actually taking the drug. At a nine-month follow-up,
three of the four women were not using amphetamines.
Respondent extinction
can be seen to be a critical component of many therapeutic or change programs,
although it is not conceptualized as extinction. Therapists, while maintaining
a non-judgmental or permissive attitude, may encourage their clients to recall
or discuss emotionally laden ideas or memories. Psychoanalysts, scientologists,
and primal scream therapists may encourage their clients to recall and relive
early painful experiences, perhaps real or unintentionally fabricated to suit
the theory. People who feel uptight about some aspect of their body may attend
a weekend marathon in which everyone goes around nude and each person tells
sympathetic listeners about a problem that brings on uptightness. Peer-evaluation
counseling may involve two non-professionals sitting down and gradually telling each other more and
more personal-emotional things. As a spiritual tool, Ram Dass (Richard Alpert)
may say to people, “anything you can think, feel, desire, fear, anything you
can bring to your mind about any of these, that you have difficulty with,
are embarrassed by, are made uncomfortable by sharing with me—share it with
me.” Some forms of meditation help people free themselves from emotional attachments
by letting their thoughts and behaviors run their course while holding in
a calm conscious space. My bias is that all these examples contain respondent
extinction as a component and realizing this can facilitate whatever is to
be accomplished.
Counterconditioning
is the reduction of
undesired elicited responses by respondently conditioning incompatible
responses to the eliciting situations. The first step is to determine the
situations that elicit the undesired responses, as spiders may cause excessive
anxiety in some people. The second step is to determine or establish ways to
elicit a response incompatible with and dominant to the undesired response,
such as some forms of relaxation may be to the spider anxiety. Finally, the
incompatible response is respondently conditioned to the stimuli eliciting the
undesired response, as stimuli producing relaxation may be paired with stimuli
related to spiders. This counterconditioning is continued until the undesired
response has been adequately reduced, usually until it no longer occurs.
Counterconditioning
is often used to reduce unwanted emotional reactions such as anxiety, anger,
or jealousy. Most clinical cases have an anxiety component that needs to
be handled in some way. Desensitization, discussed in Chapter 5, is the counterconditioning of anxiety with relaxation. In other
situations, the undesired response is a rewarding, approach response, as occurs
in some aspects of alcoholism, drug-addiction, and over-eating. The sight
of a bar may elicit a craving for a drink or the taste of one cigarette may
lead to smoking another. In these cases, counterconditioning may involve conditioning
in an unpleasant or aversive response to the stimulus situations eliciting
the approach response. This is called aversive counterconditioning and
will be discussed in Chapter 6.
It is important in
counterconditioning that the incompatible response be dominant to the undesired
response. Sometimes this is not a problem. For example, in aversive counterconditioning
the aversiveness of electric shock or imagining unpleasant scenes may be dominant
to the pleasing effects of having a second piece of pie. However, response
dominance is often an issue. The way to insure the incompatible response is
dominant is through the use of a hierarchy, similar to the gradual approach
of respondent extinction. That is, rather than immediately starting with counterconditioning
to the situation that most strongly elicits the undesired response, we begin
with a situation which weakly
elicits the undesired response. We then apply our counterconditioning to a sequence of situations, the hierarchy, that gradually approximates the
situation which most strongly elicits the undesired response. In the case
of a person with a fear of spiders, our counterconditioning using relaxation
would begin with items low on the hierarchy (such as the word “spider”), work
up the hierarchy through intermediate items (such as a picture of a spider),
on to items at the top of the hierarchy (such as touching a live spider).
The assumption is that the effects of the counterconditioning generalize (carry
over to similar stimuli) up the hierarchy, thereby gradually reducing the
strength of the undesired response elicited by the various situations. In
the example of the spider anxiety, it may be that at the beginning of treatment
the anxiety elicited by a picture of a spider or touching a live spider is
dominant to any relaxation we can
produce. But our relaxation is dominant to the
anxiety elicited by the word “spider”; so we begin our counterconditioning there. Now as we countercondition out the anxiety
to the word “spider” it is assumed the counterconditioning carries up the
hierarchy and reduces somewhat the anxiety to the picture and the live spider.
By the time we get to the picture, our relaxation is dominant to any remaining
anxiety, which we can now countercondition out. And this counterconditioning
generalizes up the remainder of the hierarchy. Thus if we choose a hierarchy
of related items, have a sufficient number of items in our hierarchy, and
do not move through the hierarchy too fast, we can insure that the incompatible
response is dominant to the undesired response and Counterconditioning will
move in the desired way. This approach will be seen in greater detail when
discussing desensitization (Chapter 5), but it is important to remember it
applies to all counterconditioning.
Counterconditioning
is not simply replacing the undesired response with the incompatible response.
Rather, it is a matter of moving along a continuum from the undesired response
toward the incompatible response. Counterconditioning may be stopped anywhere
along the continuum with the usual stopping point being some neutral middle
point. Thus with the spider anxiety we would probably countercondition until
the person felt neutral (not anxious, not relaxed) toward spiders, although
we could countercondition less and leave some anxiety or countercondition
more so we get relaxation. Aversive counterconditioning may be part of a program
with a female homosexual to reduce sexual arousal to females. We would probably
stop at the point the client felt neutral to females rather than continuing
until she felt aversion. On the other hand, if we had a male client who would
go to jail if he exposed himself at a playground again, it may be desirable
to continue the counterconditioning until aversion is elicited in this situation.
Although the explanation
of counterconditioning used in this discussion is practical for behavior modification,
on a theoretical level it should be considered highly tentative until considerable
more research is done related to the basic assumptions. Guthrie (1935) was
one of the first major theorists to consider counterconditioning, and his
conceptualization was similar to how counterconditioning is described above.
Wolpe (1958) introduced the concept of reciprocal inhibition, borrowed
from physiology, to account for counterconditioning, primarily desensitization.
The assumption is that counterconditioning generally involves one part of
the nervous system physiologically inhibiting another part, as desensitization
may involve the parasympathetic nervous system inhibiting the sympathetic
nervous system. Critics (e.g., Wilson & Davison, 1971) of this concept
of reciprocal inhibition to account for counterconditioning suggest that the
concept is an unnecessary addition to our explanation and not well supported
by physiological research. However, “reciprocal inhibition” is a common expression
in behavior modification related to counterconditioning.
In both respondent
extinction and counterconditioning, the client is presented with the CS or
a gradual sequence of approximations to the CS. Procedurally, the only difference
between the approaches is that in counterconditioning we present stimuli or
training that leads to an incompatible response to be associated with the
CS. This similarity between the two approaches allows some theorists to assume
they are the same. Thus it is possible to argue that counterconditioning is
simply extinction. The purpose of the incompatible response is for motivation
and/or to facilitate the extinction process. Desensitization, as the most
common example, may be seen as extinction rather than counterconditioning
(e.g., Wilson & Davison, 1971). The role of relaxation is a way to motivate
the client to work through the hierarchy and/or reduce anxiety so the client
is in a better state for extinction.
On the other hand,
my bias and the position of theorists such as Guthrie is that respondent extinction
is counterconditioning. The assumption is that extinction is not the passive
weakening of a behavior, but the learning of new, perhaps incompatible, behaviors.
If this position is correct, then in counterconditioning you are providing
the client with an incompatible behavior, while in extinction you are relying
on the incompatible behavior occurring some other way. Hence counterconditioning
is potentially more effective.
But whatever the
theoretical explanation for counterconditioning and how it differs from extinction,
it is clear what to do procedurally in applied situations. Next I turn to
relaxation, the most commonly used response for counterconditioning anxiety.
RELAXATION
Teaching a client how to relax is often a powerful and needed therapeutic approach just in itself, for our culture provides more and more potential sources of stress and anxiety; and few people ever learn effective ways to relax. Thus many people report they are often anxious or uptight. This may be associated with specific fears, a racing mind, or inability to get to sleep easily. Also each year more research (e.g., Holmes & Masuda, 1972; Seligman, 1975) relates many physiological problems, such as colds, ulcers, and cancer, to the stress a person experiences and how the stress is handled. Thus relaxation training is a common part of many programs. It is often useful to introduce this training early in clinical sessions because it calms the client down, shows him you have some powerful tools at your disposal, and gives the client a sense that there are things he
can do about his
own behavior.
Thus several programs
have been geared toward teaching people how to relax and use this as a self-control
skill (Goldfried & Trier, 1974; Mikulas, 1976a; Sherman & Plummer,
1973). The people learn how to sense when they begin to feel anxious and learn
how to relax instead. They learn how to handle stressful situations, as well
as how to reduce specific problems such as tension headaches, nervous muscle
movements, and anxiety-produced distortions in thought and perception. Learning
to relax is also an important component in treating insomnia (Borkovec
et al., 1975; Nicassio & Bootzin, 1974). For these reasons, the best type
of relaxation procedure is one in which the client learns a skill of relaxing
rather than has something done to him to make him relax (e.g., drugs).
The most-used relaxation
training in behavior modification is some shortened variation (see Bernstein
& Borkovec, 1973) of the muscle relaxation procedure developed by Jacobson
(1938). This involves the client alternately tensing and relaxing various
muscles while focusing his attention on the different feelings. With instruction
and practice, the client learns how to relax himself “at will”; identify the
onset of stress or anxiety earlier, which facilitates self-control; and generally
become more aware of the muscles in his body, which may reduce a variety of
problems, such as unconscious chewing on the tongue, headaches resulting from
muscle tension in the neck and head, excessive wrinkling of the face, and
poor posture.
A variation on this
relaxation training is cue-controlled relaxation (Russell & Sipich,
1973) in which the person, while relaxed via muscle relaxation and focusing
on his breathing, associates a word such as “calm” or “control” with the relaxed
state. The person can then use this word to help cue in the relaxed state.
There are many other
ways of training and producing relaxation (White & Fadiman, 1976) that
may be useful with different clients, problems, or situations. Hypnosis, in
addition to facilitating relaxation, can also be used to increase the client’s
motivation for parts of the program and may improve visualizing scenes in
the imagination, if this is part of the treatment. On the other hand, hypnosis
varies in effectiveness with clients and involves many dangers for the practitioner
lacking substantial training. Autogenic training (Lindeman, 1973; Luthe, 1969)
is a form of relaxation training similar to self-suggestion. It involves giving
yourself such suggestions as “My right arm is heavy,” “My heart beats calm
and regular,” and “My forehead is cool.” Autogenic training packages well
with biofeedback. Biofeedback (Chapter 7), as it relates to relaxation,
involves the use of machines to tell clients how anxious or aroused they are
in terms of some physiological measure such as muscle tension, skin resistance,
or skin temperature. This biofeedback information helps the clients learn
to relax and is particularly useful when a set of muscles requires specialized
attention. Meditation is being used more in behavior modification (e.g., Berwick
& Oziel, 1973; Boudreau, 1972); and besides facilitating relaxation it
is also useful when the client needs to learn to calm his mind (e.g., insomnia,
racing mind) or just generally get a little more perspective on his life.
Finally, drugs such
as tranquilizers or breathing a mixture of oxygen and carbon dioxide (Ley
& Walker, 1973) may be used to produce relaxation. Ideally, they would
only be used as a temporary adjunct to the treatment program and would gradually
be phased out. But however relaxation is produced, once a person is relaxed
or can relax on cue, we can use relaxation to countercondition anxiety.
Anxiety is the most
common emotional reaction that is counterconditioned; relaxation is the most
common incompatible response used to countercondition anxiety; and
desensitization is the most common way to countercondition anxiety with
relaxation. However, many other incompatible responses, elicited or facilitated
by the practitioner, may be used to countercondition anxiety, such as laughter,
assertive behavior, anger, music-elicited responses, eating, emotive imagery,
and aversion relief. An incompatible response other than relaxation may be
chosen because it is difficult to get the client to relax, the other response
is already strong in the client’s repertoire, or the other response is one that
independently needs to be strengthened.
Laughter is a good
response for counterconditioning anxiety, if the person can learn to laugh
at himself or the situation. At first, it may be necessary for the client
to alter the situation in his imagination to facilitate making it seem humorous.
Ventis (1 973) described a case of a coed who was anxious about attending
a banquet at which she would encounter her ex-boyfriend. A humorous image
involving the boyfriend was used for counterconditioning. After one session
and a brief hierarchy she was able to attend the banquet that evening with
little discomfort.
Assertive behavior
is often used to overcome anxiety, for many people are anxious in situations
in which they are unassertive. Learning to be appropriately assertive
(see Chapter 8) may be an important part of social skill training with the
client, as well as being a source of behaviors that will countercondition
anxiety.
When using anger
to countercondition anxiety we generally do not want to condition the person
to feel anger in the anxiety situations. Rather we use the principle of counterconditioning
that lets us stop at the intermediate neutral point. Goldstein and associates
(1970) begin by having the client in the consulting room pair anger-arousing
imagery, plus vocal and motor behavior, with imagined situations that elicit
anxiety. Later, the client uses the anger-arousing imagined images for counterconditioning
in vivo (real life) situations. The anger-arousing scenes can be used
both for counterconditioning and as a self-control procedure for handling
anxiety, these two functions often going together in counterconditioning.
Butler (1975) used anger to countercondition a variety of fears in his client,
including a fear of traveling more than about eight blocks from home (a form
of agoraphobia, fear of open spaces). Treatment involved the client imagining
an anxiety- provoking scene and responding with anger, angry verbalizations,
plus vigorous muscular activity.
Lowe (1973) used
the excitatory responses elicited by music to counter-condition anxiety in
a client who had trouble learning to relax. The client was a former rock guitarist
who would get excited by particular music and could augment the excitement
by imagining such things as he was performing the music.
In a classic study,
Jones (1924) used eating as one of the responses to countercondition a fear
of rabbits in three-year-old Peter. The rabbit was introduced
in a cage in the far part of the room where Peter played
and ate. Each day the rabbit was brought closer (a hierarchy) until it was
out of the cage and in Peter’s lap. This counterconditioning generalized to
other furry objects that Peter had also been afraid of. (Jones was a student
of Watson, whose conditioning of little Albert was mentioned at the beginning
of the chapter.)
Emotive imagery is the counterconditioning of anxiety with
images that arouse feelings such as pride, affection, self-assertion, or mirth.
Therefore, it obviously overlaps with other counterconditioning approaches
being discussed. So far it has primarily been used with children who are not
easily trained to relax. With adults, emotive imagery may combine well with
desensitization. The originators of the approach, Lazarus and Abramovitz (1962),
treated a ten-year-old boy who feared the dark by using his passion for the
radio series “Superman” and “Captain Silver.” Treatment involved the boy imagining
a story involving himself, Superman, and Captain Silver. In the story he imagined
himself in situations that gradually became darker. At the end of the third
session he was able, without anxiety, to picture himself alone in his bathroom
with all the lights turned off, awaiting a communication from Superman. This
treatment eliminated the fear of the dark and was accompanied by an improvement
in school work and a decrease in insecurity.
Aversion relief
refers to the offset of an aversive event, such
as the offset of electric shock. This offset, assumed to be pleasant, can
be paired with words such as “calm” or used to countercondition anxiety by
pairing the offset with an anxiety situation. This approach has not been used
much, particularly with the number of preferable alternative approaches. It
comes up the most in situations where the onset of an aversive event is being
used for aversive counterconditioning (Chapter 6). A form of aversion relief
is respiratory relief, which is based on the relief following holding your
breath. Treatment of anxiety would involve having the person hold his breath
and then begin breathing when presented with an anxiety situation (e.g., Orwin
et al., 1975).
New approaches to
countercondition anxiety continually come up in the literature, and creative
practitioners will find many other ways that suit their particular cases.
Kass, Rogers, and Feldman (1973) report several cases in which they counterconditioned
anxiety with responses specific to the different individuals. One woman became
distressed at being called names, which then led to fighting. Treatment involved
her imagining herself laughing at the person calling her names. Another client
was anxious about being alone, rejected, or in crowds. This was counterconditioned
with a scene in which she was lying in bed looking at new drapes. And in another
case, job anxiety was counterconditioned with sitting up exercises.
All of the logic and
examples that apply to counterconditioning anxiety with relaxation also apply
to the counterconditioning of other unwanted emotional responses such as anger,
jealousy, or frustration. For example, Hearn and Evans (1972) used a
desensitization-type approach in which relaxation was used to countercondition
anger in student nurses. And Cotharin and Mikulas (1975) used a
desensitization-type approach to reduce racially related emotional responses in
high school students. Following this, white students could interact pleasantly
with black students whom before they felt uncomfortable with and had to avoid.
Now relaxation is
just one of many incompatible responses we can use to countercondition these
unwanted emotional responses. We could use many of the incompatible responses
mentioned above for counterconditioning anxiety. For example, Smith (1973)
describes a case in which he used humor to countercondition anger. The client
was a 22-year-old female who could not control her extreme anger responses
with her husband and three-year-old son.
The child’s misbehavior generally
elicited extreme rage, including screaming, breaking things, and physically
attacking the child. A hierarchy of situations was constructed, and the items
of the hierarchy were greatly exaggerated to make them humorous. Counterconditioning
with this hierarchy reduced the anger the situations elicited, gave the client
control over her temper, and allowed her to view anger eliciting situations
more objectively.
In general then,
we can probably countercondition any unwanted, conditioned, emotional response
(e.g., anxiety, anger, racially related emotional responses) with any incompatible
response (e.g., relaxation, humor). Since we can stop our counterconditioning
at a neutral point, it often may not matter whether the incompatible response
is desirable or not. All this gives the practitioner enormous flexibility
in tailoring a counterconditioning program to his client’s specific problems
and skills. The choice of what incompatible responses to use for counterconditioning
depends on which such responses the client already has in his repertoire or
could readily learn and which responses would be profitable to learn for reasons
more than counter- conditioning (e.g., relaxation, assertive behavior), My
bias is that most, if not all, changes in affect that occur in any non-physiological
treatment program, regardless of the theory behind the treatment, is because
of respondent extinction and/or counterconditioning. Seeing it from this perspective
may result in the practitioner being more aware of the need to strengthen
or establish incompatible responses and perhaps use a hierarchical approach.
Masters and Johnson
have determined more about the
human sexual response and its dysfunctions than
anyone else in history. Their program for the treatment of sexual dysfunctions
(Belliveau & Richter, 1970; Masters & Johnson, 1970) is still the
classic work in this field; and many other programs (e.g., Hartman & Fithian,
1972) have drawn on their work in varying degrees and added other treatment
components. The Masters and Johnson treatment program has basically two overlapping
parts, educative counseling and behavioral assignments. The educative counseling
involves general sex education, discussion of motivation to change, discussion
of basic problems, and instruction in the treatment approach. This is coupled
with history taking, general assessment, and physical examinations. The behavioral
assignments consist of programs, geared toward the specific type of dysfunction,
that the couple carries out with each other in private.
Although Masters
and Johnson conceptualize their treatment program as a form of psychotherapy,
the behavioral assignments are much like behavior modification with counterconditioning
playing a large role. A major part of most of the treatment consists in eliciting
the sexual response in a non-coital situation, then gradually moving through
a hierarchy of steps leading to coitus while maintaining the sexual response.
The implicit assumption is that the sexual response will gradually countercondition
the responses (e.g., anxiety) which are impairing the sexual response in coitus.
Thus a man with impotence, often unable to achieve or maintain an erection
sufficiently for coitus, will first be stimulated to erection in a non-coitus
situation. Then while maintaining and restimulating the erection, the male
is gradually moved through a sequence of steps leading to coitus. A similar
approach is used with a female with orgasmic dysfunction, seldom or never
experiencing an orgasm. First the woman’s sexual response is elicited in non-coitus
situations. Then she moves through a sequence of stages toward coitus. Other
things are involved in the treatment of these and other sexual dysfunctions,
but counterconditioning seems to be a significant component.
Viewing the Masters
and Johnson program from the behavior modification position suggests several
ways the program can be improved (see Murphy & Mikulas, 1974). For example,
in many cases anxiety is impairing the sexual response. Now Masters and Johnson
are using the sexual response to countercondition the anxiety that is impairing
the sexual response. This may often work, particularly with a good hierarchy.
But sometimes the anxiety is too great. Many of the cases they report as failures
are cases in which too much anxiety exists. This suggests the addition of
something like desensitization to first reduce some of the anxiety. There
is also a need for more individualizing of the hierarchies. For many people
the first step in the behavioral assignment may be too anxiety producing.
For others, the items in the hierarchy need to be geared more toward their
specific problems. Masters and Johnson believe the sexual response will naturally
occur if they can just remove the obstacles. A behavior modifier may go further
and initiate or strengthen the sexual response to specific situations. This
would probably involve respondent conditioning and perhaps the use of sexual
fantasies, masturbation, vibrators, or pornography.
A case study by Davison
(1968) will finish this section as it illustrates various aspects of counterconditioning.
The client was a 21-year-old, unmarried male who was only sexually aroused
by sadistic fantasies, involving torturing women, which he masturbated to
about five times a week. He dated little and showed no interest in girls.
The first step was for the therapist to argue against any disease interpretation
of the client’s unusual behavior.
This is common as
the behavior modifier often has to reduce his client’s fears about being inherently
sick, abnormal, or evil. Davison’s next step was counterconditioning: The
client was instructed to masturbate while looking at pictures of sexy, nude
women, using his
sadistic scenes to occasionally help initiate or maintain arousal and erection. From these pictures the
client slowly moved along a sequence of pictures of women with more and more
clothes on and finally to imagined situations from real life. Now Davison
was helping and encouraging the client to begin asking out girls. Finally,
aversive counterconditioning was used to reduce the sexual arousal to the
sadistic fantasies. This involved associating in the imagination a sadistic
fantasy with an unpleasant image, such as drinking from a bowl of urine and
feces. All of this produced a decrease in sadistic fantasies and a positive
sexual feeling toward girls. Six months after treatment ended,
the client used what he had learned to return to sadistic fantasies for a while and then reverse
it back. At this point he found he had no need for sadistic fantasies
and was involved in a relatively vigorous program of dating.
Respondent
conditioning is the learning model in which a stimulus situation comes to
elicit a relatively new response or increase in response because of association
with other stimulus situations.
Formally, the conditioned stimulus (CS) comes to elicit the conditioned response (CR) because of the
person learning that the CS is associated with (provides information about) the
unconditioned stimulus (UCS), which elicits the unconditioned response (UCR).
In most situations, respondent conditioning is best when the CS comes on about one-half second before the onset of the UCS and
the UCR is dominant to the response originally elicited by the CS. Respondent
conditioning is sometimes used in behavior modification to
establish or strengthen a response, as in the treatment of enuresis or in
building in sexual arousal to a situation. Undesired respondent behavior is
changed by respondent extinction or counterconditioning, both of which may or
may not be done gradually with a hierarchy of intermediate steps. Extinction
consists in presenting the CS without its being paired with the UCS until the
CR is suitably reduced. Counterconditioning consists in conditioning a desired
response to the CS to gradually replace the undesired response, with a
hierarchy often used to control response dominance. Practically, extinction and
counterconditioning only differ in the degree to which the practitioner
facilitates the occurrence of an incompatible response. Relaxation training, a
useful procedure in itself, is also part of programs for the self-control and
counterconditioning of responses such as anxiety. Anxiety can be
counterconditioned with a range of incompatible responses, including
relaxation, laughter, assertive behavior, anger, musicelicited responses,
eating, emotive imagery, aversion relief, physical exercise, and sexual
responses. Similar responses can be used for the counterconditioning of many
other behaviors, including anger, jealousy, frustration, racially related
emotional responses, and aspects of sexual dysfunction. Aversive
counterconditioning is counterconditioning in which a response to an unpleasant
stimulus, such as electric shock or imagining an aversive scene, is gradually
conditioned to stimuli that elicit undesired, but pleasant approach behavior,
as in parts of alcoholism or addiction to other drugs.
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1.
|
Define
respondent conditioning, respondent extinction, and counterconditioning.
What are the practical and theoretical differences among them? For each
give a real life example you have observed. |
|
2.
|
Discuss
the variables of respondent conditioning as they may relate to a case
in which you are reducing anxiety with emotive imagery. |
|
3.
|
Describe
at least five different ways to
teach or produce relaxation in a client. For each give a situation in which this method would be the preferred approach.
|
|
4.
|
Describe
a hypothetical case in which you countercondition anxiety with a response other than one of those mentioned in the
chapter. Why would you use this particular response for this case? |
|
5.
|
Describe
a hypothetical case in which you use humor to countercondition jealousy. |
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6.
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Describe
covert extinction using a hierarchy for the reduction of test anxiety. |
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7.
|
Consider
any of the things you value. To what extent may respondent conditioning
have been involved in the learning of this value? Give possible examples.
Does understanding part of the cause of the value affect the value itself?
Why? |
Bernstein, D. A.
& Borkovec, T. D. Progressive
relaxation training: A manual for the helping professions. Champaign, Ill.: Research Press, 1 973.
Eysenck, H. J. &
Beech, R. Counterconditioning and related methods. In Bergin, A. E. &
Garfield, S. L. (eds.), Handbook of psychotherapy and behavior change: An empirical analysis. New York: Wiley, 1971.
Salter, A. Conditioned reflex therapy. New York: Farrar, Straus & Giroux, 1 949. Capricorn paperback, 1961.