Assumptions
Consider the
following small sample of problems that psychologists, teachers, parents, and
other change agents must deal with: What are effective ways of helping a person
control or eliminate unwanted emotions such as some anxiety, anger, jealousy,
aggression, and racial prejudice? What basic approaches are available to us to
facilitate the reduction of nervous habits, epileptic seizures, stealing, and
littering? What concrete things can be done when a person wishes to reduce
overeating, smoking, or the consumption of alcohol or other drugs? How does one
deal with insomnia and nightmares? If a client has a sexual dysfunction or is
only sexually aroused by “inappropriate” objects, what can be done to eliminate
the problem and facilitate desired sexual behavior? How can a person increase
motivation in himself, a prison, a ward in a mental hospital, or a work
Organization? What are effective ways for a person to learn to relax, quiet his
mind, and control unwanted thoughts? What constructive things can we tell a
parent about child rearing, toilet training, and bedwetting? In school
classrooms, what are effective ways of motivating the students, dealing with
disruptive behavior, and individualizing instruction as much as possible? Given
the enormous number of people seeking clinical and counseling help and the
relatively small number of highly trained practitioners, how can we most
effectively and efficiently help these people while maximizing the use of
available human resources?
This book describes
one approach, behavior modification, which deals with the above problems,
among many others. The reason behavior modification can deal with such a wide
range of problems, with varying degrees of effectiveness, is because the approach
draws on several basic principles of human behavior that cut across many different
problem areas and situations. Experimental studies are the main ways we refine
our understanding of human behavior and evaluate and evolve our behavior modification
practice.
Behavior modification
is the application of experimentally
established principles of behavior to problems of behavior. Currently, it
draws most heavily from studies, not theories, in the areas of learning and
motivation, although behavior modification is not restricted to these areas.
When used in settings that are primarily seen as clinical, behavior modification
is often called behavior therapy or conditioning therapy. Behavior modification
is sometimes equated with applied operant conditioning (see Chapter
7), which is just a part of behavior modification and more accurately
called experimental analysis of behavior.
In the last few years
some writers have used the term behavior modification to refer to almost
any practice that alters human behavior. But this is not the case. More specifically,
behavior modification is not brainwashing or mind control, and behavior modifiers
do not use psychosurgery or electroshock therapy and only occasionally use
drugs as a temporary adjunct to a change procedure. Rather, behavior modification
is structured learning in which new skills and other behaviors are learned,
undesired reactions and habits are reduced, and the client becomes more motivated
for the desired changes.
Behavior modification
is experimentally based. The assumption of psychology is that there is a set
of laws that describes factors which affect a person’s behavior. If a person’s
behavior is changed, regardless of what the procedure is called (e.g., behavior
modification, analysis, influence, non- directive counseling), the change
must be based on these laws. And the closer the treatment procedure comes
to using these laws, the more effective it is. It is not known exactly what
these basic laws are, but the experimental psychologist believes that the
information from experimental studies is the best approximation we have at
present. The practice of behavior modification includes the technology of
applying these principles to human problems. (Note that behavior modification
is more a technology than a philosophy of the nature of human beings.) As
various change procedures are developed, they too are experimentally studied
in terms of such questions as how effective are different-approaches for diff
rent problems and how can a specific procedure be improved. Therefore, behavior
modification is continually evolving and improving. This book is intended
to give the reader a brief conceptual overview of the whole field of behavior
modification. Therefore, it
is not possible or desirable to review all the
related experimental research. However, I have included many references so
the readers may be directed to that research literature they wish to inspect
in more detail.
Among the many
factors that influence human behavior are genetic variables, physiological
abnormalities, nutrition, and electromagnetic radiation. Treatment of some
problems may thus involve changing the person’s diet or removing a brain tumor.
Other physiological factors such as genetic predispositions for some forms of
schizophrenia, abnormally reactive nervous systems, biochemical imbalances in
the brain, and mental retardation generally cannot be directly treated at
present. Hence they must be considered part of the “personality” of the person
(see Mikulas, 1974b, chap. 7) and seen as givens or constraints for whatever
change procedures are applicable. Behavior modification may not be able to
eliminate the retardation, but it can help the retarded person lead the most
fulfilling life possible. Similarly, many problems that before were primarily
treated by purely medical approaches are now seen to be best treated by
coupling the medical approach with behavior modification (Katz & Zlutnick,
1974; Knapp & Peterson, 1976; LeBow, 1976).
However, when one
looks at the range of psychological problems, such as those at the beginning
of this chapter, one finds that the major variables responsible for the majority
of most problems are variables related to learn ing and motivation. In
some cases, this involves behaviors that were learned at one time or situation,
but are considered undesirable at another time or place. Small children may
be knocked down a few times by large dogs and develop a fear of dogs. If this
fear persists into adulthood, persons with the fear may wish to rid themselves
of it. People who began smoking cigarettes as teenagers for social approval
may find several years later that they have learned a complex smoking habit
which is difficult to eliminate for more than a short period of time.
On the other hand,
many problems involve behaviors that the person has not learned, but needs
to learn, such as how to study, relax, handle anxiety, or be more assertive.
Behavior modification then draws strongly on learning and motivation, and
much of the practice consists of helping people reduce undesired learned behaviors
and learn new desired behaviors.
Throughout this book
I will be conceptualizing behavior from a learning-motivation position. But
psychology is overflowing with personality
theories and clinical approaches that offer
alternative ways of conceptualizing behavior. What are the relationships between
these various models and why choose one over another? To some extent it is
a matter of translation: How do the constructs and approaches of model A translate
into the constructs and approaches of model B? Are the “strokes” of transactional
analysis the same as “reinforcement” in behavior modification? In this context,
many writers (Dollard & Miller, 1950; French, 1933; Kimble, 1961, chap.
14; Krasner, 1962; Sargant, 1959; Shoben, 1949; Truax, 1966) have attempted
to show that what takes place in various forms of therapy and counseling can
be explained from a learning orientation. However, the issue is much more
than one of translation, for the various models often contain assumptions
that lead to incompatibilities. In Chapter 10, after the reader has a better
understanding of behavior modification, I will raise this issue again and
suggest some relationships between behavior modification and other models.
There are a number
of advantages to a learning-motivation based model. One is that the constructs
are relatively “clean”; they are well defined with a minimum of excess meaning
and associations. This facilitates an objective understanding of behavior.
A second advantage is that learning and motivation, perhaps more than any
other model, suggest complex interrelationships of the various constructs
in a way useful in understanding and treating human problems that involve
complex interweaving of many behaviors.
From about the time of Freud until fairly recently the predominant
way of thinking about and
treating psychological problems has been the medical model. The
assumption of this approach is that abnormal behaviors are products of more
basic underlying causes within the psychological system, such as a
subconscious conflict based on early childhood experiences. If a person reports
a fear of snakes, this is merely a symptom of an underlying cause. In
this case, the snake is usually seen as a sexual symbol; and the fear of snakes
is based on sexual anxiety or castration fears. Similarly, one theory of
alcoholism is that the drinking behavior is a result of a more basic cause of latent
homosexuality. The medical model has so infused our culture that many people
automatically assume it must be true. A disadvantage of this way of thinking is
that undesired behaviors are often seen as a product of a basic pathology or
psychological disease, an attitude which may lead to clients feeling more
helpless or worse about themselves. A common early step in behavior therapy is
reducing the client’s beliefs and fears about being diseased or mentally ill in
some sense.
Treatment based on
the medical model requires procedures—such as psychoanalysis--aimed at the
underlying cause, not the behavioral symptom. This usually involves the
client gaining insight into the underlying cause and/or reliving and dealing
with early experiences, often of a psychosexual nature.
Psychology as a science
is very young, most of the information having been acquired in the last 30 years. Thus around the turn of the century, psychology
was basically a subset of philosophy. Freud then built his medical model based
on his medical training, his experiences with hysterical and neurotic clients,
and his work with hypnosis. He and other medical model theorists generated
a large number of creative and important ideas about human behavior, many
of which have been refined and incorporated into the experimental literature
and many of which have not held up and have been significantly altered or
rejected.
Over time, many psychologists
became dissatisfied with the medical model. One reason is that many of the
basic concepts of the different theories (e.g., ego, id, power-striving, inferiority
complex) were not defined so they could be adequately measured. Without adequate
measures it is always questionable whether a construct is applicable to an
individual or whether purported changes in a construct have taken place. This
led to many different theories, all of which could explain people’s behavior
within their own theoretical constructs. But without better measures of the
constructs it is difficult to choose between alternative explanations or alternative
approaches to change procedures. Behavior modification defines its constructs
in as measurable a way as possible.
A second question
about the medical model concerns the idea of an underlying cause. Is a person’s
fear of snakes actually based on something like sexual anxiety? Medical models
assume yes; learning-based models assume no. From a learning approach a person
acquired a fear of snakes through some combination of experiences such as
actual bad experiences with snakes; bad associations to snakes via stories,
cartoons, religious tales, and the like (our culture is extreme in its bad
treatment of snakes); and/or acquiring the fear from someone else, often a
parent, who has the same fear (see Chapter 8).
It is also likely that humans as a species have a predisposition to acquiring
a fear of snakes (Seligman, 1971) or perhaps even some degree of an innate
fear that is coupled with learning (Gray, 1971, p. 1 5).
This issue of the
underlying cause is raised again below in the discussion of symptom substitution
and again in Chapter 1 0 when considering the relationships between behavior
modification and psychoanalysis. But if, in fact, there is no reason or need
to trace an underlying cause, then one’s treatment program can generally proceed
significantly faster.
A major problem for
all change agents, which is related to medical model types of conceptualization,
is the tendency to explain behavior problems in terms of some characteristic
of the person, rather than a functional understanding of the behaviors. A
teacher might explain why a student misbehaves in class in terms of the student
being a slow learner, or being from a broken home, or from a minority group.
A foreman might account for a worker’s poor work performance in terms of the
worker being a loner or not identifying with the company. Behavior modifiers
look at behavior more functionally—what are the conditions supporting this
behavior? Being from a broken home does not make a child misbehave in class.
Rather, when we functionally examine the behavior, we will probably discover
something like the fact that the child gets peer approval for his misbehavior
and has not learned other ways to get this attention. (Perhaps being from
a broken home impaired his learning alternative behaviors.) We can easily
help the child learn more acceptable and useful ways of gaining social approval;
we cannot easily change the fact he is from a broken home. Similarly, by systematically
studying the worker with poor work performance, we may find that he needs
skill training related to his job or that the union would punish him for working
harder.
Behavior
modification then, as the name implies, is concerned with behavior, what does
the person do. Behavior here is meant in the broadest sense,
including overt behavior that is readily observable, covert behavior such as
thoughts that are generally inferred from what the person tells us, various
emotions, and subtle activity of the nervous system. In all cases we define the
behaviors as objectively as possible within the confines of the practicality of
the situation and the limits of our technology.
Behavior modification
arose from the school of psychology called behaviorism, an approach
that suggests the study of psychology should emphasize the understanding,
prediction, and control of behavior. The first major statement of a behaviorist
position was that of Watson in 1 91 3. Watson’s approach was a variation of
methodological behaviorism, which argues that mental events cannot
be scientifically studied since you cannot get agreement about what goes on
in the mind. Watson held an extreme point of view in that he only considered
the study of overt behavior as scientifically valid and attempted to reduce
thinking to movements of the vocal cords and tongue. He emphasized the necessity
for objective study of overt behavior, although he allowed for covert behavior.
Many critics of modern behav iorism and behavior modification
use Watson’s form of behaviorism as a straw man. They suggest behavior modification
disregards people’s thoughts and feelings, treating them as empty organisms
or white rats. In reality, although these criticisms may apply to some practitioners
of many orientations, the field of behavior modification is not at all like
that. Since its beginnings, behavior modification has been concerned with
people’s feelings, particularly anxiety. And Chapter 9 discusses the relationship
of mental events to behavior and the application of behavior modification
to thoughts.
Similarly, Skinner
(1974) is the foremost spokesman for behaviorism today. He suggests a form
of behaviorism called radical behaviorism, which recognizes and studies
mental events as internal behaviors. Skinner’s views and approach to behaviorism
are not the same as all behaviorists practicing behavior modification. However,
Skinner is important reading for students of behavior modification.
The type of behaviorism
being suggested here is not an attempt to reduce all human behavior to a few
simple reflexes or stimulus-response associations. Rather, it is an appreciation
of the enormous complexity of human behavior and an attempt to understand
this complexity in terms of interrelationships of component behaviors. Breaking
behavior down into its components need not detract from an understanding of
the person as a whole; instead it facilitates developing an effective change
program. The component behaviors are not conceptualized as specific responses
being learned to specific stimuli, but rather are classes of behaviors learned
to classes of situations.
By focusing on behaviors,
behavior modification provides practical information about what to do in real
situations. While in school the student of clinical psychology may explore
and debate various psychological- philosophical models of human behavior;
but when sitting down with a client who is a sexually impotent alcoholic reporting
general feelings of depression, what is the practitioner going to do? This
client wants concrete, practical help now! A new teacher may have many creative
ideas for educating fifth graders and individualizing instruction. But when
he gets his first class he finds thirty different students with a wide range
of academic backgrounds and behavior problems. He is spending much of his
time as a Policeman rather than an innovative educator. What is he to do?
Sometimes understanding
a problem or seeing why he acts in some way may help a person deal with a
problem. Perhaps the person has the skills to overcome a problem once the
problem is understood. But usually this is insufficient Thus behavior modification
does not depend on understanding, insight, or being able to interpret behavior
from some theoretical model as sufficient for behavior change. Rather, people
may need help in learning alternative behaviors or skills that are not in
their repertoire. A woman in a Consciousness-raising group may discover she
needs to be more assertive with her husband. But this knowledge does not teach
her to be appropriately assertive without, for example, becoming too aggressive.
In behavior modification we have specific ways of helping a person learn appropriate
assertive behaviors (see Chapter 8). Or consider
fears. Probably just about everyone reading this book has some type of undesired
fear or source of anxiety, such as fear of spiders, fear of snakes, fear of
heights, test anxiety, or anxiety about speaking before a particular group
of people. Does your knowledge of this fear, your feeling the fear is irrational,
or your ability to interpret the fear in terms of some theory eliminate the
fear? Probably not. Behavior modification provides specific ways of helping
people handle anxiety and eliminate fears.
This does not mean
that understanding or insight is not present in behavior modification, only
that it is often insufficient. In fact, behavior modification practices often
encourage clients to observe and understand the causes of their behavior.
This type of awareness or discrimination learning is often necessary for a
thorough assessment and often is the first step in helping the person develop
self-control of some behaviors. The relationship between understanding and
behavior change will be covered in a little more detail in Chapter 9.
Working with behavior
problems often involves a variety of different components. In some cases,
there is a need for education or clearing up misconceptions. This is common
in the treatment of sexual problems. Sometimes the client needs encouragement,
permission, or a good listener. Sometimes the client needs medical aid, vocational
training, driving lessons, or a new set of teeth. But beyond all of this the
behavior modifier has a practical approach of what to do to deal with
a range of behaviors that need to be increased or decreased.
A concern of people
from the medical model orientation is that behavior modification only treats
the symptoms without getting at the underlying cause. If the underlying cause
is not treated, it may simply manifest itself in terms of some other symptoms,
a phenomenon called symptom substitution. This type of reasoning causes
some people to reject a behavioral approach as only tinkering with symptoms.
The issue, however,
is not as clear as it first seems. Symptoms and underlying causes have not
been well defined. It is not clear exactly what constitutes a symptom, when
substitution should occur, or when you have reached an underlying cause. It
is not clear why one must make the assumption of symptom substitution; such
an assumption is compatible, but unnecessary, from even a medical model or
psychodynamic approach (Weitzman, 1967). Freud allowed this as just one possibility.
The issue becomes
an empirical one: Does something such as symptom substitution follow treatment
of behaviors? The answer appears to be no. A large number of studies (e.g.,
Baker, 1969; Lazarus, 1963; Nolan et al., 1970; Paul, 1967, 1968; Wolpe, 1961;
Yates, 1958) has shown that if the treatment of the behaviors is adequately
carried out, seldom does anything that resembles symptom substitution occur.
The key word is “adequately,” for if the practitioner does not treat all the
relevant behaviors, then the untreated behaviors, or behaviors resulting from
them, might be interpreted as symptom substitution (Cahoon, 1968). Some examples
of this follow.
Many behaviors are
maintained by anxiety. Consider, for example, a person who feels anxious in social situations and has adopted smoking as
a means to reduce anxiety.
If the behaviorist merely stopped the smoking behavior, the person might turn
to some other anxiety-reducing behavior, for example, excessive drinking.
Superficially, it would appear that symptom substitution had occurred.
However, if the behaviorist treated the behavior of feeling anxious, as well
as the smoking behavior, then there should not be a substitute symptom. Now
the reader may wish to think of anxiety as some type of underlying cause in
this case, and this is fine. But this is not how most medical model theorists
would think of an underlying cause. And the anxiety in this situation is readily
reduced from a behavioral position, as will be discussed in Chapter 3.
For treatment purposes,
many people are taken from one environment and placed in another: A child
is removed from a public school and placed in a special training school, an
adult is taken from his home and institutionalized, or a drug addict is removed
from society and placed in a treatment center. If, after treatment, clients
are returned to their original environment, the old surroundings and friends
may trigger some of the old behaviors, which may then be strengthened. A followup
study might report relapse or symptom substitution, when in fact return of
the undesired behavior was because of the environment the clients were returned
to. This underscores the importance for all practitioners to systematically
investigate and, if possible, alter any environments in which they place their
clients.
The issue of symptom
substitution was raised often in the early days of behavior modification,
in the late 1950s and early 1960s. But it is not mentioned much anymore in
the professional literature, primarily because of lack of empirical support.
However, I still encounter it
often when talking with lay people and undergraduates.
It is an interesting example of the extent to which medical model assumptions
have been accepted into large parts of our culture.
1. Behavior
modification is ahistorical. It does not matter how the individuals
got where they are or acquired certain problems. The question is What do we do
here and now? What currently elicits and maintains undesirable behaviors? What
behavioral deficits currently exist? This does not mean we disregard historical information, for it is often useful. But
historical information is used to help determine current variables affecting
behavior. Sometimes historical information is unnecessary. If we had a case of
a student with test anxiety, it might take a long time to determine the events
of the past that led to test anxiety. Fortunately, we can probably adequately
reduce the anxiety in a few hours without knowing the genesis. Also, the
genesis of some current problem may be another earlier problem that might now
be resolved and need not be brought up again. Being ahistorical, behavior
modification is often faster than approaches that require tracing down
historical causes.
2. Behavior modification
avoids labeling and categorizing people and the use of words such as “abnormal.”
Classification systems may be useful for some administrative and communication
purposes and may suggest some variables to look at during assessment. But
a label or category usually adds little to a functional analysis of the behaviors.
On the other hand, labeling the person may be detrimental to the person (as
will be discussed in the next chapter) or may cause the practitioner to overlook
behaviors unique to that person.
Adjectives such as
“abnormal,” “deviant,” and “mentally ill” are often used to describe people
and behaviors. But these are basically social- political constructs by which
people in a particular culture at a particular time define acceptable and
unacceptable behaviors. Homosexuality in our culture is generally considered
deviant. But this attitude has been changing in our culture; and in some cultures,
such as some early Greek cultures, homosexuality was considered superior to
heterosexuality. Similarly, some creative people and great leaders show behaviors
that are infrequent (not normal) in our culture, but does this make them deviant
or abnormal? Such terms are too poorly defined to be of much use. Behavior,
regardless of how it is classified (e.g., normal versus abnormal), is acquired
and can be modified by the same principles of learning and motivation. Whether
the behavior is acceptable or not to some people or cultures is a separate
ethical issue.
3. Behavior modification
is sensible. The reasoning of behavior modification or some specific program
can often be explained to clients, teachers, parents, ward attendants, and
others in a way that “makes sense” to them. They need not accept some theoretical
model or learn specialized terminology. When working with a client you can
both know where you are going and why. When working with ward attendants in
a mental hospital you get better results and cooperation when you reason with
them. If you point out how one patient throws food in the cafeteria because
it results in the nurse going and sitting with him, then it is possible to
suggest reasonable ways to reduce the food throwing. On the other hand, if
you describe the patient in nonsensical ways to the ward attendant, you should
not expect much help from the attendant in your treatment program. If parents
go to a child psychologist, they usually want some reasonable and specific
suggestions for specific problems. They are probably not interested in psychological-philosophizing
or categorizing the child’s behavior or developmental stage.
4. One of the greatest
advantages of behavior modification is that it does not require a one-to-one
relationship between the behavior modifier, who establishes and supervises
the programs, and the clients. Thus the behavior modifier can train teachers
to carry out programs in classrooms (Doerr, 1 975) and parents to carry out
programs with children (Berkowitz & Graziano, 1972; O’Dell, 1974; Sloop,
1975). This is more effective and efficient than trying to deal with all the
individual children, particularly when the parents and teachers are often
unknowingly responsible for the misbehavior they wish to change. In this context,
numerous behavior modification books have been written specifically for teachers
and parents (see Chapter 11). Similarly,
ward attendants can learn to implement programs in mental hospitals (e.g.,
the token economies of Chapter 7). In one program
working with juveniles, the psychologist supervises the behavior analysts
who supervise the mediators who work with the youth (Tharp & Wetzel, 1969).
And others are investigating how behavior modification procedures can be used
in the training of people to carry out behavior modification (e.g., Loeber
& Weisman, 1975). The importance of such programs is that more people
and paraprofessionals can be effectively used in the treatment program, more
people can be directly helped, and the behavior modifier can spend more of
his time on general programs and specialized problems.
In addition, some
behavior modification programs can be carried out with groups of people at
a time. And in many situations, automation can do many of the tasks for people
(Butterfield, 1974; Elwood, 1975; Schwitzgebel & Schwitzgebel, 1973).
For all these reasons, plus the emphasis on self- control mentioned next,
more people can be treated more efficiently and cheaper than approaches requiring
a one-to-one relationship between the client and a highly trained practitioner.
5. Finally, a large
part of behavior modification is concerned with self-control, approaches geared
toward teaching people how to carry out change programs on themselves (see
Chapter 11). This has many advantages, including
freeing the practitioner’s time and hence less expense to clients, greater
attitude and behavior changes if clients attribute the changes to themselves,
the clients learning general strategies that they can apply in a variety of
situations, and the possibility of catching problems early or even Preventing
them from occurring. People may learn these self-control skills and programs
from popularized magazine articles or books (e.g., Alberti & Emmons, 1975;
Fensterheim & Baer, 1975; Robbins & Fisher, 1973), selfcontrol clinics,
television shows on self-control (Mikulas, 1976a), or individual counseling
and training. In addition, several written self-control programs are being
developed to help people learn by themselves such things as how to improve
study habits (Beneke & Harris, 1 972); lose weight (Hagen, 1974; Hanson
et al., 1976); and control premature ejaculation, the tendency of a male to
ejaculate too quickly in intercourse situations (Lowe & Mikulas, 1975).
Thus more and more behavior modification information is being distributed
to people at large, so people can better understand, control, and direct their
own behavior.
Overall then, behavior
modification is a relatively new, evolving field that already contains a fast,
efficient, and powerful technology for behavior change. It is an important
literature for all change agents and people who wish to understand their own
behavior, regardless of how they wish to incorporate this information into
their own models.
From experimental
studies of behavior, including studies of learning and motivation, psychology
is evolving an understanding of basic principles of behavior that may be seen
in a wide range of situations. Behavior modification is the technology of
applying these principles to problems of behavior, reducing undesired behaviors
and teaching desired behaviors, while continually experimentally evaluating and
improving the various approaches. As much as possible, the constructs of
behavior modification are defined in ways that are readily measurable. The
emphasis is on behavior, what does the person do, including overt and covert
behaviors. The practitioner focuses on the complex interrelationships of current
behaviors rather than on the historical causes or development of these
behaviors. Behavior modification does not require a one-to-one relationship
between practitioner and client. People can learn self-control skills and carry
out programs on themselves; parents, teachers, and paraprofessionals can learn
how to help implement programs with others; groups of people can often be treated at one time; and many aspects of different
programs can be automated.
|
1.
|
What are the strengths and limitations of trying to specify human behavior in terms that can be objectively measured? |
|
2.
|
Define
“mental illness” and “abnormal”. Discuss these definitions from a practical
standpoint. |
|
3.
|
Define
“behaviorism” in its broadest sense. What are the strengths and weaknesses
of this approach? Why? |
|
4.
|
What
properties must a change procedure have to be considered behavior modification
as described in this chapter? |
|
5.
|
To
what extent is or was your thinking about human behavior influenced by
the medical model approach? Why? |
|
6.
|
When
would understanding the nature or cause of a behavior problem be sufficient
to eliminate the problem? When would it not be sufficient? Give specific
examples. Think of examples from your own life. |