This article explains the basic concepts involved in classical conditioning, and how classical conditioning concepts integrate into many cognitive behavioral treatment protocols.
a. Give particular attention to the role of avoidance behavior
b. Discuss how CBT protocols combat avoidance
c. Explain why, theoretically, these treatments work, especially for anxiety based disorders
Basic Concepts of Classical Conditioning:
Possibly the most common example of classical conditioning involves Ivan Pavlov (a Russian physiologist and experimental psychologist) and his dogs.
Pavlov discovered that through what is now called classical conditioning, he could provoke his experimental subjects—dogs—to salivate as a conditioned response to hearing a bell ring (a conditioned stimulus).
Review of terms:
1-Unconditioned Stimulus (US): This is something a person will naturally react to.
2-Unconditioned Response (UR): This is the way in which a person will naturally react to something.
For example, if a person touches a hot pan he/she will naturally recoil—pull his/her hand away from that pan. No one needs to be taught to do this; the reaction to pull one’s hand away is natural, it is unconditioned. Therefore, in this example, the unconditioned stimulus is the hot pan, the unconditioned response is to pull one’s hand away from the hot pan.
For Pavlov’s dogs, the unconditioned stimulus was food, in specific presenting the dogs with the view of ground meat. The unconditioned response was salvation. Dogs do not need to be taught to salivate in response to food; it’s natural (as it is with humans).
3-Conditioned Stimulus (CS): This is a stimulus that normally would have no effect (create no response) but does create a response because it is associated with an unconditional stimulus.
4-Conditioned Response (CR): This is one’s reaction to a conditional stimulus.
In Pavlov’s experiment, he was able to make his dogs salivate not only to food (unconditioned stimulus), but also to the sound of a bell ringing (conditioned stimulus). He did this by presenting the sound of a bell just prior to showing his dogs food. The dogs would hear the bell, then see the food, and salivate. Eventually however, the dogs would begin to salivate even before they saw the food (conditioned response)—they would salivate simply by hearing the bell ring because they associated the sound of the bell with the presence of food, even when food was not present. Interestingly, Pavlov noticed in his research that the dogs not only salivated to the sound of the bell, they would also salivate when they saw Pavlov—for he, being the person who always provided his dogs with food—incidentally made himself a conditioned stimulus.
Role of Avoidance Behavior:
Coincidentally, this ability to condition a response to stimuli applies to humans just as it applies to animals. Remember the example with the person pulling his/her hand away from the hot pan? Well, though the reaction to heat is unconditioned the reaction to seeing a pan on a stove with the dial on high, is conditioned. one learns—even if one does not notice any heat—that pans on the stove are not to be touched.
Furthermore, (hopefully) one learns this quickly. A person only needs to touch a hot pan once to remember not to touch pans on the stove. This is because pain is a strong conditioner, as are emotional or traumatic experiences. Sometimes URs are very beneficial, as in the pan example, though sometimes they interfere with persons lives, and are de-habilitating. Consider this scenario:
July, a 21-year-old college student, one night after leaving the library is attacked and raped in the school parking lot. From that night on she is terrified of parking lots at night, and avoids them at all costs. This is true (1) even though she knows the chance of her being attacked again is very unlikely and (2) even in the presence of a protective friend her terror is sustained. Furthermore, even thinking about parking lots at night (while in a safe place) makes her extremely nervous.
July, in this example, has associated parking lots at night (CS) with being rapped (CR). Therefore, though fear of being attacked (UR) is normal in the presence of an attacker (US) it is present even without the presentation of an attacker (CR).
Avoidance Behavior:
Stated above, since July has acquired a strong CR to parking lots at night, she avoids them. This avoidance, instead of dissipating over time, may actually increase in intensity overtime. Consider the flow chart below:
Exposure of anxiety provoking stimulus (Anxiety increases and becomes unpleasant)→ Avoidance or escape→ anxiety lessens → failure to understand the stimulus is not harmful → reinforcing avoidance.
In explanation, July has a fear of parking lots and this provokes anxiety. When she actively avoids parking lots at night (possibly by planning her schedule so that she will not have to encounter one), the anxiety she has decreases, or disappears completely. Therefore July begins to associate avoiding parking lots with relief from anxiety (another conditioned response), and in consequence her avoidance behavior increases, instead of decreasing.
How CBT Protocols Combat Avoidance:
Treatment for this avoidance behavior and for the CR of fear of parking lots at night will involve several avenues. First, July must become aware of her irrational belief that she will be attacked again if she is in a parking lot at night. This primary fear may actually be of her recollection of her attack—she may be afraid she will re-experience the attack in her mind (rather than fear another attack).
In order for the conditioned stimulus to lose power, a person must be exposed to the stimulus and be able to understand that the CS is harmless. In brief, in the case of July, she should be slowly introduced to parking lots at night—made to imaging them, made to visit parking lots during the day, during twilight, and finally at night time.
July may also be asked to picture her attacker, for the memory should have no effect on her anymore. The memory of an attack is not an attack, is in essence a conditioned stimulus. Here is a flow chart that details how a CBT protocol combats avoidance:
Exposure of anxiety provoking stimulus (Anxiety increases and becomes unpleasant)→ no avoidance, no escape (anxiety gets worse)→ Anticipated terrible outcome does not manifest itself (anxiety lessens) → client understands the stimulus is not harmful → avoidance of stimulus lessens.
In explanation, July has a fear of parking lots and this provokes anxiety. When she is forced to experience parking lots at night (a progressive process, possibly by imagining one in her mind first, then later by visiting one at dusk, then later still visiting one at night), her anxiety level increases. However, when nothing horrible happens (i.e. July realizes she is safe) the anxiety lessens or disappears completely. Therefore, July begins to break the association between parking lots and being attacked, and in consequence her avoidance behavior decreases.
From a cognitive behavioral perspective, how would you describe depression so that a client could understand it? Keep in mind that this rationale should make direct links to the kind of treatment interventions you would use.
Statistics for Depression
Depression is the most common of all mental disorders with 25% of women and 12% of men developing major depression at some point during their lifetime.
However, it is usually alleviated with 12-16 sessions of CBT
On occasion, sessions may last 6 months to 2 years.
Although,
75% of clients experience significant reduction of depression within 20 sessions.
85% experience significant reduction of depression when CBT is combined with medications.
Treatment Interventions:
According to Burns, in conquering depression, there are four steps to battling depression:
1-Identify the Upsetting Event
This is where one specifically identifies issues in his/her life that are suspected to facilitate him/her being upset
2-Record Negative Feelings
With this step, the client is to mention specific feelings in affiliation with the upsetting event (anger, sadness, despair, etc.) and rate the power of each feeling from 0-100 (0 being having little or no power, 100 being an extremely powerful feeling).
3-The Triple Column Technique
This step is where the client is to identify his/her:
(1) Automatic thoughts in response to the upsetting event (what are you thinking right when this happens?), and the power the thoughts have (1-100).
(2) The distortions in his/her automatic thoughts (i.e. if the auto. Thought is everyone will hate me, the distortion would be that it is improbable that anyone, let alone everyone will actually hate me).
(3) Replacing the automatic response with a rational response (i.e. no one will hate me, a couple people might be annoyed, but they will forgive me).
(4) Re-rate one’s belief about the upsetting event (often it is not nearly as depressing as one supposed it to be).
Cognitive Distortions:
Burns identifies many distorted thoughts that can facilitate depression. As seen above, replacing these distortions with rational thoughts will help to improve one’s mood (alleviate depressive symptoms).
1) All-or-nothing thinking: one looks at issues as always black and white, there is no intermediate area (i.e. Since I am not prefect, I must be worthless).
2) Overgeneralization: viewing a negative occurrence as total defeat (i.e. I messed up. Therefore, I will always mess up).
3) Mental Filter: Dwelling on the negatives and ignoring the positives.
4) Discounting the positive: when one’s accomplishments don’t count, but failures do (i.e. so what if 99 of my attempts went well? I really blew it this one time).
5) Jumping to conclusions: includes mind reading (I bet everyone hates me) and fortune-telling (I bet they will think I’m horrible).
6) Magnification or minimization: events are made either much more or much less important than they really are.
7) Emotional Reasoning: (i.e. I feel foolish right now. Therefore, I must be an absolute fool!)
8) Should Statements: criticizing your self with erroneous shoulds (i.e. I should not be making any mistakes. I should be perfect all the time).
9) Labeling: Instead of telling yourself you acted like a jerk, you tell your self “I am a jerk.”
10) Personalization and Blame: blaming yourself for something that was not entirely your fault (i.e. the team lost because of me). Or blaming others for something that wasn’t entirely their fault (i.e. we are divorced because she was horrible).
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