Behavior therapies based on the procedures of classical conditioning focus on the process of:

Abstract

Classical conditioning describes associative learning where stimuli are sometimes paired to produce clinical problems including most anxiety disorders. Extinguishing problematic responses that arise through classical conditioning is the focus of many psychotherapy procedures. This article describes the basic principles of classical conditioning, how understanding these principles helped clarify our understanding of the etiology of clinical problems, and how exposure-based treatments were developed to reduce or eliminate these problems. Recent cognitive explanations regarding the change process in humans are described. Finally, some attempts to add pharmacological adjuncts to improve the efficacy of exposure are reviewed.

Conclusion

Classical conditioning in animals and humans has undoubtedly contributed to a substantial increase of insights in the neural network subserving various forms of associative learning in the motor, cognitive, and emotional domain. Although the exact neurobiological mechanisms of cerebellar involvement in motor, cognitive, and emotional associative learning remain to be elucidated, enormous progress has been achieved in delineating the neural circuitry involved in eyeblink conditioning as the prototype of motor associative learning. In addition, a variety of experimental, clinical, and neuroimaging studies based on paradigms that closely relate to classical conditioning revealed that cerebellar disorders have a detrimental effect on cognitive and emotional associative learning as well. The contribution of the cerebellum to motor, cognitive, and emotional associative learning may relate to the role of the cerebellum in motor control processing, i.e., correct prediction of upcoming events associated with particular stimuli and/or actions. Overall, cerebellar circuits are growingly recognized as critical associative centers for sensory information seen in a broad sense. Associative learning is another example on the historical progression from a pure motor point of view to a more global sensorimotor contribution for cerebellar modules. Further investigations are still needed in larger groups of patients with circumscribed lesions to identify which parts of the cerebellum are crucially implicated in the various forms of associative learning.

Involuntary Learning: The Theory of Classical Conditioning

Classical conditioning demonstrated involuntary or reflexive learning through association with stimuli. The founder of the theory, Ivan Pavlov (1849–1936), was a Nobel Prize-winning Russian physiologist and neurologist whose earlier research focused on involuntary reflexes of animals and later extended to children. In Pavlov's (1927) experiment on animals' digestive systems, he found that dogs learned to salivate when the sound of a bell was repeatedly paired with the presentation of food. Later, the learned response to salivate upon the sound of the bell continued even without the presentation of food. This automatic form of learning is what is called ‘conditioning.’ Watson extended Pavlov's finding into the study of more complex reflexes, such as emotional response. In a controversial experiment, he conditioned a young child named Albert to develop a fear of rats and objects that resembled them.

In education, the theory of classical conditioning provides the basis for understanding and treating test anxiety, school phobia, and similar conditions. For instance, test anxiety is a physiological response that can be unlearned if the presentation of tests is repeatedly associated with a stimulus that elicits pleasant emotion in students (Legge and Harari, 2000); teachers should consistently present nonthreatening testing environments to induce a positive reaction in their students.

Abstract

Eyeblink conditioning is a classical conditioning procedure that has been used extensively to investigate the neural mechanisms underlying associative learning and memory. The cerebellum ipsilateral to the conditioned eye is essential for eyeblink conditioning. Conditional stimulus (CS) and unconditional stimulus (US) input arising from the pontine nuclei and inferior olive, respectively, converge upon the cerebellar cortex and deep nuclei. Combined input from the CS and US pathways during training trials induces synaptic plasticity in the cerebellar cortex and anterior interpositus nucleus. These two sites of synaptic plasticity constitute the memory necessary for the eyeblink conditioned response. A future direction for this research is to determine the cellular and molecular mechanisms underlying cerebellar learning.

4 Clinical Interventions Involving Operant and Respondent Conditioning

Respondent (also known as classical, or Pavlovian) conditioning (see Classical Conditioning and Clinical Psychology) involves the pairing of unconditioned and conditioned stimuli, which ultimately leads to a conditioned stimulus that elicits a conditioned response. One of the more useful clinical heuristics has been research on how respondent and operant conditioning can combine to explain important clinical problems.

The best-known problem that has been addressed by considering both operant and respondent conditioning is the theory of the acquisition and maintenance of phobic behaviors. It has been suggested that phobic behaviors are acquired by classical conditioning but maintained by operant conditioning. Consider the simple example of someone bitten by a dog. In respondent conditioning terms, the dog bite is an unconditioned stimulus that produces the unconditioned response of pain and fear. Following such an incident, the next time the person approaches a dog, their fear and anxiety rises as the stimulus (the dog) gets closer. So far, the acquisition of the fearful response can be understood using a classical conditioning paradigm. If the person were to approach a variety of dogs, the fearful response would extinguish naturally, because extinction in classical conditioning is accomplished by presenting the conditioned stimulus (a dog) in the absence of the unconditioned stimulus (the dog bite). If this were the case, phobic responses would extinguish naturally over time. However, in many instances when one sees the dog and anxiety increases, a person simply turns around and walks away, thus avoiding the feared object. When that happens, the avoidance behavior is negatively reinforced (increased) by the removal of the anxiety. This increases the probability of avoiding the dog the next time such a stimulus is encountered. The avoidance of the phobic object prevents the natural extinction of phobic anxiety, because the phobic object (now a conditioned stimulus) is avoided and therefore extinction cannot occur.

Avoidance is an important issue in clinical psychology. Avoidance responses are operants that prevent the occurrence of aversive consequences before they are actually experienced. This behavior is maintained by negative reinforcement. Clinically, the liability of avoidance behavior is that the person engaging in such behavior does not experience the opportunity to test whether the anticipated aversive consequences are still in effect. Thus, the circumstances that led to the initial aversive consequences may have changed, but if the person continues to avoid the original stimulus conditions, the changes will go undetected. There may also be avoidance of other stimuli due to generalization that leads to additional restrictions in healthy functioning.

Several clinical interventions address such problems. Treatments for phobias involve therapeutic interventions that prevent or remove the instrumental benefits of avoidance. Phobia treatment involves a classical conditioning paradigm in which the behavior therapist uses exposure to the conditioned stimulus to bring about extinction (see Behavior Therapy: Psychological Perspectives). The key to successful treatment is the prevention of avoidance, which would negatively reinforce the phobic behavior (Barlow 1990).

Another clinical problem that is treated, in part, by preventing avoidance behavior is obsessive-compulsive disorder (OCD). In OCD, the client experiences intrusive thoughts or images that produce anxiety. For example, someone might be obsessed with a concern that they have failed to lock their house adequately. The thoughts are high in frequency, do not feel natural to the client, and are not under the voluntary control of the client. Obsessions are thoughts or images. They are often accompanied by compulsive behaviors that serve to reduce the obsessive thoughts. In this example, a client may go back repeatedly to check that the front door is locked, preventing them from going to work. The psychological intervention used to treat OCD is exposure to the situation that produces the obsessive behavior and response prevention so that the compulsive behaviors are not emitted (Foa et al. 1980). Eventually, the anxiety associated with the problematic stimulus extinguishes, because the function of acting to reduce the distress extinguishes.

Cognitive Behavioral Therapy

CBT is based on both Pavlov's theory of classical conditioning and B.F. Skinner's theory of behavior modification (Tatarsky, 2002). Behaviorism could not account for all types of behavior; hence CBT was developed to integrate abstract thoughts and feelings with concrete behaviors. CBT has been typically described as problem focused and action oriented. Individual choice is an important construct. Clients are accountable for their cognitive approach to ‘problems’ and their choice of behaviors. Action is located in the here and now (Tatarsky, 2002).

CBT does not ignore past trauma, shame, or guilt; however, action and accountability cannot occur in the past or future. Action is possible only in the present. Within the cognitive behavioral paradigm, all behavior is conceived of as changeable if clients are motivated to change. Clinicians structure session content to increase interpersonal competence and decrease interpersonal vulnerabilities. Substance abuse intervention utilizes cost/benefit analyses, decisional balancing, and relapse prevention planning. These techniques require the client to engage actively in the present through the use of behavior logs. For example, drink-monitoring cards record the elapsed time and number of standard drinks an individual consumes in a given day and the social context of their drinking behavior. Clinicians process their daily drinking logs with patients to assess any manifestation of cognitive dissonance.

Learning Theories

The earliest theory of learning in modern psychology explains behavior in terms of classical conditioning – learning to associate one thing with another. Pioneered by Pavlov, this approach suggests that once people mentally pair things together, they become ‘conditioned’ to expect those things to always occur together. This theory was later supplemented with theories of operant conditioning developed by Thorndike and Skinner, which suggest that people are more likely to repeat a behavior that has been rewarded and less likely to repeat a behavior that has been punished. In aggression research it has been shown that children can be taught to behave aggressively through rewarding aggressive behavior (positive reinforcement) or removing a painful consequence after aggression (negative reinforcement). In addition, children learn to discriminate between situations where aggression has a desirable consequence and when it does not, and to generalize this knowledge to new situations. Although such research demonstrates that aggression can be learned through conditioning (e.g., Eron et al., 1971), it was clear by the 1960s that such processes could not explain the acquisition of all learned aggression.

Bandura proposed that social behaviors, including aggression, could be learned through observing and imitating others (i.e., via observational learning). In his classic experiments, children observed a film of an actor hitting a ‘Bobo Doll’ in several novel ways. The children later imitated the behavior in the absence of any classical or operant conditioning. Bandura also developed the concept of vicarious learning of aggression, and showed that children were especially likely to imitate models that had been rewarded for behaving aggressively. In social learning theory (later called social cognitive theory), Bandura hypothesized that the way people mentally construct their experiences is crucial. People may see one person hit another, but will also decide how competent they feel to do the same, and will make assumptions about what constitutes a normal way to respond when someone provokes you. In this way, making inferences about observed aggression not only increases the likelihood of imitating it, but also expands the range of situations to which that response might be generalized (see Bandura, 1986). There is considerable research support for social cognitive explanations of aggression. People sometimes imitate aggressive models, especially if the aggressive behavior is rewarded or carried out by a person who is heroic, admired, of high status, attractive, or similar.

III.D Cognition

Where in the body does learning leave its traces as people learn from Pavlovian and operant conditioning, assisted with information from models, words, rules, and scripts? The brain is the organ that processes and stores the inputs gained through all types of learning, including sexual learning. During learning experiences, perceptual inputs from all sense modalities trigger thoughts and feelings in both primitive and advanced brain areas. Sensory and motor experiences that are associated with reinforcement or punishment are especially likely to be entered into the brain's long-term memory systems.

Our thoughts are filled with two basic components: (1) perceptual images from present sensory inputs, along with the memory images that they arouse, and (2) the “inner words” that we “hear” in our minds as we use language to label perceptual and memory inputs in the privacy of our brains. Both nonverbal and verbal inputs can elicit emotional responses that heighten the “feelings” of inputs that are associated with reinforcers or punishers, whereas other inputs are neutral, with little or no emotional association.

Sexy images and words can come from real-life personal experiences or from indirect social learning via movies, TV, videos, and photos. When people see TV shows, videos, or movies in which certain lines, scripts, postures, or clothing lead to sexually exciting outcomes, they may find themselves repeating and rehearing those scripted events in their brains and then using parts or combinations of those scripts when interacting with others. The more that scripted words, actions, and images are associated with rewards, the more people come to like and use them.

Each person's vocabulary and verbal knowledge are gifts from society. Some people receive generous verbal gifts that allow them to cogitate about sex—and all the rest of life—in great detail. Other people receive limited or highly censored verbal labels and knowledge about sex. People who have many detailed words for describing most aspects of sexuality can have more complex “inner verbalizations” for analyzing their sexuality in the privacy of their own brains than can people with limited vocabularies. Highly verbal people can cogitate for hours about the details of a sexual experience that a less verbal person might summarize in a few words, “It was good.” Unfortunately, if the verbal information a person is given about sex is wrong, the many hours of self-analysis can lead to faulty conclusions, such as, “As long as I douche afterward, I won’t be able to get pregnant.”

Every human brain resides in a unique body that, in turn, is located in a singular place in time and space. Hence, each individual is influenced by his or her special position in the world. Two people living in different parts of the same city are exposed to different subsets of the multiple subcultures existing in that city; hence, they learn different information about sexual conduct from their different symbolic and real-life models. Some people obtain vast amounts of information about sex and pregnancy, relationships, birth control, and STDs, whereas others obtain little.

Each person has a singular perspective on life, and each brain learns unique thoughts about sex and gender; thus, 100 people can perceive the same event and interpret it 100 different ways. After two people see the same erotic movie, one describes it as interesting and sexually exciting, whereas the other calls it repulsive and pornographic. One person wants to imitate the behavior modeled in the movie, and the other sets limits and refuses to do the behavior. As they gain experience, people who live in pluralistic societies with many different views and values about sex often become more tolerant of sexual diversity as they hear many different points of view about life.

The brain is not a passive organ or a simple memory bank that is filled by personal and social experience. The brain is an active, dynamic, and creative organ that can modify and reconstruct the scripts and scenes it perceives in the world around it. Most people learn how to combine and recombine various inputs in creative new ways, play with ideas, free-associate, and then talk and act in creative ways. Problem solving and fantasy often enhance the brain's creative processes. Problems often cause people to search for creative solutions. When people confront new difficulties, such as increasing boredom with sex after 3 years of marriage, the problem may stimulate creative efforts to devise novel and interesting sexual experiences. Fantasies are a second stimulant of creativity. As people imagine sexual activities they have never done before, they may consciously attempt to create special sexual experiences that are uniquely their own. Through the creative recombination of different rules, scripts, fantasies, and novel ideas, people can construct sexual plans and actions that differ from anything they have ever done in the past or seen others do. Although most creative acts are not radically different from things that other people in their culture do, they do contribute to the cultural innovations that add spice to life.

The Problem: A Resistance to Killing

Much of human behavior is irrefutably linked to a mixture of operant and classical conditioning. From one perspective, grades in school and wages at work are nothing more than positive reinforcers, and grades and money are nothing more than tokens in a token economy, and the utility of behaviorism in understanding daily human behavior is significant.

Yet the purist position (which holds that behavioristic processes explain all aspects of human behavior) is generally considered to be flawed in its application to humans, since humans are able to learn by observational learning, and humans tend to strongly oppose and negate blatant attempts to manipulate them against their will. But in emergency situations, or in the preparation of individuals for emergency situations, behaviorism reigns supreme.

Those in power have always attempted to utilize the basic behavioral concepts of rewards, punishments, and repetitive training to shape or control, and in many cases they would hope, predict the responses of military and law enforcement personnel throughout history Certainly, in ancient times when there was no formal understanding of the underlying precepts of conditioning, military leaders nevertheless subjected their troops to forms of conditioning with the intention of instilling warlike responses.

Repetition played heavily in attempting to condition firing as seen in Prussian and Napoleonic drill in the loading and firing of muskets. Through thousands of repetitions it was hoped that, under the stress of battle, men would simply fall back on the learned skill to continue firing at the enemy. While this may have accounted for some increase in the firing of muskets in the general direction of the enemy, statistics from the Napoleonic era do not bear out the hit ratios that would indicate success in the method, success being determined by increased kill ratios.

In tests during this era it was repeatedly demonstrated that an average of regiment of 250 men, each firing a musket at a rate of four shots per minute, could hypothetically put close to 1000 holes in a 6-foot high by 100-foot wide sheet of paper at a range of 25 yards. But Paddy Griffith has documented in his studies of actual Napoleonic and American Civil War battles that in many cases the actual hit ratios were as low as zero hits, with an average being approximately one or two hits, per minute, per regiment, which is less than 1% of their theoretical killing potential. While these soldiers may have been trained to fire their weapons, they had not been conditioned to kill their enemy.

In behavioral terms, to prepare (or train, or condition) a soldier to kill, the stimulus (which did not appear in their training) should have been an enemy soldier in their sights. The target behavior (which they did not practice for) should have been to accurately fire their weapons at another human being. There should have been immediate feedback when they hit a target, and there should have been rewards for performing these specific functions, or punishment for failing to do so. No aspect of this occurred in their training, and it was inevitable that such training would fail.

To truly understand the necessity for operant conditioning in this situation, it must first be recognized that most participants in close-combat situations are literally “frightened out of their wits.” Once the arrows or bullets start flying, combatants stop thinking with the forebrain (which is the part of the brain that makes us human) and thought processes localize in the midbrain, or mammalian brain, which is the primitive part of the brain that is generally indistinguishable from that of a dog or a rat. And in the mind of a dog the only thing which will influence behavior is operant conditioning.

In conflict situations the dominance of midbrain processing can be observed in the existence of a powerful resistance to killing one's own kind, a resistance that exists in every healthy member of every species. Konrad Lorenz, in his definitive book, On Aggression, notes that it is rare for animals of the same species to fight to death. In their territorial and mating battles, animals with horns will butt their heads together in a relatively harmless fashion, but against any other species they will go to the side and attempt to gut and gore. Similarly, piranha will fight one another with raps of their tails but they will turn their teeth on anything and everything else, and rattlesnakes will wrestle each other but they have no hesitation to turn their fangs on anything else. Lorenz suggests that this nonspecicidal tendency is innately imprinted into the genetic code in order to safeguard the survival of the species.

One major modern revelation in the field of military psychology is the observation that this resistance to killing one's own species is also a key factor in human combat. Brigadier General S. L. A. Marshall first observed this during his work as the chief historian of the European Theater of Operations in World War II. Based on his innovative new technique of postcombat interviews, Marshall concluded in his landmark book, Men Against Fire, that only 15%–20% of the individual riflemen in World War II fired their weapons at an exposed enemy soldier.

Marshall's findings have been somewhat controversial, but every available, parallel, scholarly study has validated his basic findings. Ardant du Picq's surveys of French officers in the 1860s and his observations on ancient battles, Keegan and Holmes' numerous accounts of ineffectual firing throughout history, Paddy Griffith's data on the extraordinarily low killing rate among Napoleonic and American Civil War regiments, Stouffer's extensive World War II and postwar research, Richard Holmes' assessment of Argentine firing rates in the Falklands War, the British Army's laser reenactments of historical battles, the FBI's studies of nonfiring rates among low enforcement officers in the 1950s and 1960s, and countless other individual and anecdotal observations, all confirm Marshall's fundamental conclusion that man is not, by nature, a close-range, interpersonal killer.

The existence of this resistance can be observed in its marked absence in sociopaths who, by definition, feel no empathy or remorse for their fellow human beings. Pit bull dogs have been selectively bred for sociopathy, bred for the absence of the resistance to killing one's kind in order to ensure that they will perform the unnatural act of killing another dog in battle. Breeding to overcome this limitation in humans is impractical, but humans are very adept at finding mechanical means to overcome natural limitations. Humans were born without the ability to fly, so we found mechanisms that overcame this limitation and enabled flight. Humans also were born without the ability to kill fellow humans, and so, throughout history, we have devoted great effort to finding a way to overcome this resistance.