Simple conditioning principles seem very relevant to planned behavior change, either in terms of setting up experiences that would allow an unwanted or mal- adaptive conditioned response to extinguish, or setting up experiences that would create new associations and allow the meaning of stimuli to change. However, learned and unlearned associations are laid down in memory, and once we have to bring memory into our explanatory picture, mechanisms become more complex again. If we experience a terrifying or otherwise highly aversive event—something like food poisoning, or witnessing someone being injured, or undergoing an unpleasant medical procedure—we rarely come away from such experiences with one emotional response conditioned to one stimulus. Instead we are much more likely to have what memory researchers call episodic memories of the experience—a quite complex recollection of the context, what we were doing at the time, and what we felt, including both the physiological changes and the interpretation we placed on those feelings (Reisberg & Hertel, 2004). Th ese emo- tional memories may depend on how the experience was encoded and then how it was stored, or consolidated, so that all the contextual and emotional elements will be remembered, often for a very long time (Smith & DeCoster, 2000).
In therapy, as in life, we encourage clients to recall upsetting, traumatic, inci- dents and to talk about them. What we want to happen is that although the facts of the incident will be remembered, the strong aff ect associated with it will fade. We want the conditioned emotion to extinguish, but not the overall memory of the events. For one thing, remembering a highly threatening or dangerous situ- ation might make us more cautious about getting into the same situation again.
If someone has had a bad car accident we do not expect or want the memory of that to completely disappear. We want people to recognize dangerous situations on the road, to wear their seat belt, to slow down, and not to talk on their cell phone while driving. But we do want the intense emotion elicited at the time to be reduced suffi ciently that the person does not develop such a strong, unfading phobic reaction that they cannot drive in a car without feeling panicked. If, on the other hand, the person carefully avoids the recall of the details of the trau- matic incident, these emotions have little chance of ever being extinguished.
Th is is basically how Levis (Levis & Malloy, 1982) explained the persistence of negative aff ect following traumatic experiences—if you do not recall them, do not think about them, and do not talk about them, the associated aff ect cannot extinguish. You are turning off the warning bell before you can experience an extinction trial. Th oughts and memories as visualized and verbalized are events with powerful stimulus properties that elicit negative emotions and cue even more negative thoughts in a chain reaction. It is a profound recognition by Levis that such an arrangement will lead to active, if mental, avoidance of such memo- ries. Because we will not engage in those painful thoughts the negative aff ect associated with them remains unextinguished. Another feature of that model is that one reason we would not want to recall, think about, and talk about an experience is because initially, when doing so, the associated aff ect is extremely unpleasant. Th erapy has to fi nd ways of encouraging the necessary recall of the memories, including picturing the situation in our mind’s eye and talking about events in considerable detail.
Cognitive theorists tend to refer to thinking about a negative experience such as a social interaction for someone with social anxiety, or a failure experience for someone with depression, as event “processing” (Dannahy & Stopa, 2007). Truly, refl ective people always evaluate their performance, reevaluate it, ratio- nalize it, and through repeated recall redefi ne the experience so that it is stored in memory for later recollection as positive, neutral, or negative, relevant or not to self and the future. Th at this process of rumination and reevaluation takes place between therapy sessions as well as within exposure treatment suggests a further way in which the therapeutic encounter (within the formal session or when talking with friends) aff ects everyday functioning, so that mood and other self-reported aspects of experience fl uctuate completely independently of the therapeutic “dose.” Nebulous as these concepts are, they support the broad idea that what a client goes away and thinks about or experiences between sessions interacts with the specifi c experiences of the session itself as well as with the homework recommended and other assigned tasks. In such a dynamic interac- tion between therapy experiences and subsequent life experiences it is no wonder that change during treatment is not—as I emphasized in Chapter 2—a smooth linear process. Th e standard session-opening therapist’s question “How was your week?” might be better posed as “What were you thinking and feeling this week about what you learned last session?”
Many circumstances enable stimulus revaluation—a safe therapeutic setting and a calming therapist who instills trust, or prior training in strategies to man- age emotion (such as relaxation, or controlled breathing), or requiring recall of the traumatic event little by little by following a hierarchy, or off ering additional hypothesized cues to probe for the recall of the memories despite the negative aff ect (that is what happens in Levis’s implosion therapy). But the one thing that would be counterproductive is allowing clients to escape the memory and not think about it just because thinking about it makes them feel bad (experiential avoidance).
P h y s i o l o g i c a l S e n s a t i o n s a s Av e r s i v e S t i m u l i
Many bodily sensations, especially those associated with fear, anxiety, and anger, are highly unpleasant. Th at is why we seek to avoid or escape them. So if someone is particularly averse to such feelings we might anticipate a strange paradox—that negative feelings give them negative feelings. Classical conditioning is about the conditioning of very basic, automatic, physiological responses—the pit in your stomach before an examination or the dry mouth before a speech, the hot fl ush of embarrassment, the heart palpitations when about you are to be attacked, and the muscle tension of anger when disrespected.
If a person has poor emotional control (regulation ability), the early sensa- tions of negative aff ect often precede a more intense, prolonged episode of emo- tion, identifi ed as a panic attack. Panic involves incapacitation and is particularly unpleasant. If bodily changes provide exteroceptive cues prior to panic, then these milder bodily sensations become CSs for conditioning further physiologi- cal change. A possible way to alter this incubation-like aff ect is to expose the cli- ent to cues while at the same time providing some combination of reassurance, support, and emotional control strategies. Creating these milder, safer sensa- tions in order to desensitize a client to them is not terribly diffi cult—heavy rapid breathing, for example, gives rise to hyperventilation, or being spun around in a chair causes feelings of dizziness
Th e key thing about any autonomic physiological responses, apart from their aversiveness, is that although easily elicited they are not easily controlled by voluntary means (Unger, Evans, Rourke, & Levis, 2003). It is possible to con- trol the motor behavior these autonomic nervous system reactions usually give rise to: just because your mouth is dry and your palms are sweating you do not have to run off the podium in the middle of your speech. But the actual sympa- thetic and parasympathetic responses themselves are very hard to stop at will. Words and thoughts having the opposite emotional value is one way of regulat- ing them. Th is is why in systematic desensitization we say to the client “think now of a PEACEFUL, PLEASANT scene.” Th is allows the physiological response to be muted when the fear-arousing, phobic stimulus is presented, either in real- ity or in imagination. Hopefully we then get extinction rather than incubation.
You cannot, however, simply alter feelings by telling people that things are safe (don’t be fearful), are not likely to eventuate (don’t be anxious), and are not their fault (don’t feel guilty).
Implications
Why, out of all the important phenomena studied in psychology, did I select classical conditioning for special attention? Th e reasons are partly historical. Behavior therapy began with the direct application of classical conditioning principles. Th is in turn led to a rich and intense relationship between psycho- logical theory and clinical practice. But in contemporary behaviorally inspired treatment protocols there are few that really resemble the classical Pavlovian paradigm and as therapists we would only very rarely use laboratory-like condi- tioning procedures with clients. What classical conditioning really represents is not a method to be followed literally, but a parable—a tale about how the value attributable to stimuli can be increased or decreased and made appetitive or aversive. In other words, classical conditioning is an explanatory paradigm that has great utility when used at the level of analogy, or of a model, rather than confi rming underlying mechanisms.
Th ere is one particularly intriguing thing about this position clinically. When a client has a fear reaction that appears to have been acquired in a traumatic incident, such as a fear of swallowing arising from an incident of near death from choking, there is little point in telling the client that it is unlikely to hap- pen again. His or her fear is not based on lack of knowledge of probabilities. Th e fear response is automatic and is not under voluntary or cognitive control. It might be in some clients. Fear of eating a raw egg might be based on erroneous information that there is a salmonella epidemic; if you have evidence to the con- trary that should allay their fear. But telling children that dogs are not danger- ous after they have been bitten by one seems to be the wrong approach, when conditioning principles are understood.
To say that classical conditioning is about the valence of stimuli certainly broadens the topic far beyond what an experimental psychologist would rec- ognize as the classical conditioning procedure . In June 2011, after an outbreak in Europe of a deadly strain of E. coli bacteria, German public health offi cials blamed cucumbers from Spain. Spanish cucumbers were no longer popular, no one would buy them, and thousands of tons had to be destroyed. Th is is not exactly classical conditioning but it is associative learning using words. People in Europe did not fear cucumbers. What they feared was getting sick and possibly dying. As Levis (1991) clarifi ed, people do not literally fear heights, they fear get- ting injured or maimed; they do not fear swimming, they fear drowning.
Th e most obvious diff erence between the laboratory study of classical condi- tioning and real life infl uences producing change is that the stimuli used in the
laboratory are all always pretty well meaningless to the subject. But in human experience with the overwhelming exposure we all have to words, pictures, and other images, the stimuli in our lives are laden with layers of emotional signifi cance and associations with other symbols rich in emotion. Americans will respond emotionally to the Stars and Stripes; in one study simply expos- ing people to a picture of the American fl ag made them react more conserva- tively and patriotically up to 8 months later (Carter, Ferguson, & Hassin, 2011). Millions of people around the world feel hope, fervor, and joy at the symbol of the Christian cross. Th ese are learned associations—you were not born feeling arousal to the blue Star of David or disgust for the red and black Swastika the same way you have inbuilt startle refl exes to loud noise or leg jerks to a blow on the patellar tendon.
Classical conditioning is about changing the valence of stimuli (including words, thoughts, and other symbols)—the input side of an organism’s interac- tion with the environment. In the next chapter we will examine the output side of the equation by considering the other major paradigm for studying learn- ing, instrumental conditioning, or what happens after the organism responds. Classical conditioning is about the rules concerning the relationship among events, regardless of the individual’s responding; instrumental conditioning is about the rules concerning the relationship between responding and the conse- quent events.
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